Clinical Investigation
Echocardiographic Reference Values in Children and Adults
Age-Specific Reference Intervals for Indexed Left Ventricular Mass in Children

https://doi.org/10.1016/j.echo.2009.03.003Get rights and content

Background

In older children, one of the standards for indexing left ventricular mass (LVM) is height raised to an exponential power of 2.7. The purpose of this study was to establish a normal value for the pediatric age group and to determine how, if at all, LVM/height2.7 varies in children.

Methods

M-mode echocardiography was performed in 2,273 nonobese, healthy children (1,267 boys, 1,006 girls; age range 0-18 years). Curves were constructed for the 5th, 10th, 25th, 50th, 75th, 90th, and 95th quantiles of LVM/height2.7.

Results

In children aged > 9 years, median LVM/height2.7 ranged from 27 to 32 g/m2.7 and had little variation with age. However, in those aged < 9 years, LVM/height2.7 varied significantly, and percentiles for newborns and infants were approximately double the levels for older children and adolescents: the 95th percentile ranged from 80 g/m2.7 for newborns to 40 g/m2.7 for 11-year-olds.

Conclusion

For patients aged > 9 years, quantiles of LVM/height2.7 vary little, and values > 40 g/m2.7 in girls and > 45 g/m2.7 in boys can be considered abnormal (ie, > 95th percentile). However, for patients aged < 9 years, the index varies with age, and therefore, measured LVM/height2.7 must be compared with percentile curves, which are provided. This variation in LVM/height2.7 in younger children indicates that a better indexing method is needed for this age group. Nevertheless, these data are valuable in that they provide normal values with which patient data can be compared.

Section snippets

Patients

The data base of the Echocardiography Laboratory at Cincinnati Children's Hospital was queried for all patients with structurally normal hearts and no systemic disease. These patients were children referred to the laboratory for the evaluation of innocent murmurs or noncardiac chest pain who were then determined by echocardiography to have normal cardiac anatomy and physiology. Patient date of birth, height (or length), weight, and gender were obtained. Height was measured by a wall-mounted

Results

Table 1 shows summary statistics for our data. There were 2,273 children (1,267 boys, 1,006 girls) in the analyses after exclusions. Average BMI and height z scores were close to zero. LVM ranged from < 6 to > 250 g for the entire population.

Table 2 shows the 10th, 25th, 50th, 75th, 90th, and 95th percentiles and ranges for LVM and LVM indexed to height2.7 for the subjects by 2-year age groupings. The only powers of age needed to create smooth (ie, fitting the calculated percentiles closely

Discussion

This study was performed specifically to address the need for a reference value for one of the most commonly used LVM indices in the pediatric population. The significant findings of this study are that indexing LVM to height2.7 must be age specific. In children aged > 9 years, values of 40 g/m2.7 in girls and 45 g/m2.7 in boys can be considered abnormal. However, in those aged < 9 years of age, a single value cannot be used, and instead, an alternative indexing method must be used. Percentile

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    Presented in part at the 15th Annual Scientific Sessions of the American Society of Echocardiography, June 26 to 30, 2004, San Diego, CA.

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